Filtros de vena cava inferior en posición suprarrenal / Suprarenal inferior vena cava filters: retrospective review of 30 cases

Background: Inferior vena cava (IVC) filters are used to prevent massive pulmonary embolism in cases where anticoagulation is contraindicated or has failed. It is usually implanted below the renal veins. In a few cases it is necessary to deploy the filter above them, with theoretical rísk of secondary renal failure. Aim: To report the experience with filters located above the renal veins. Patients and Methods: Medical records of all patients with percutaneous suprarenal filters are reviewed. Results: Between May 1993 and May 2007, 361 percutaneous IVC filter procedures were performed. In thirty patients aged 19 to 77 years (average 48years, 50 percent males), they were placed in suprarenalposition (8,3 percent). Suprarenal IVC filters were implanted in patients with extensive caval thrombosis, renal vein thrombosis extending to cava, displacement of previous IVC filters and double IVC system. Jugular vein approach was the access of choice. Technical success was 100 percent, no death or pulmonary embolism occurred. Patients were followed from 1 to 165 months (average 57 months). Eight deaths were recorded, five in patients with cáncer No patient had renal failure on follow up (average creatinine 0.90+0,26 mg/dL). Three patients developed a new deep vein thrombosis (10 percent), without pulmonary embolism. Conclusions: In this retrospective analysis of patients, suprarenal placement of IVC filters was not associated to secondary renal failure, and showed good short and long term results.

Tratamiento endovascular de la disección aórtica tipo B mediante endoprótesis / Endovascular treatment of type B aortic dissection

Background: Dissections that involve the ascending aorta are classified as type A, regardless of the site of the primary intimal tear, and all other dissections as type B. Type B dissections can have fatal ischemic and hemorrhagic complications. In the chronic state, dilatation and rupture can be mortal. Endovascular surgery is a therapeutic alternative, considering the high rate of complications of conventional surgery Aim: To report the results of endovascular treatment of type B aortic dissection. Material and methods: Report of 36 treated patients (30 males) aged 43 to 87 years, with a type B aortic dissection. Seventy eight percent were hypertensive and 39 percent smoked. The diagnosis was conñrmed by CAT sean. Acute patients were treated for complications and chronic patients, for dilatation. In the operating room, an endoprothesis was placed through the femoral artery, to cover the tear. The tear was located and the lumens were differentiated using angiography and transesophageal echocardiography. Results: All procedures were successful. In 16 acute dissections the indications were malperfusion syndrome or unmanageable hypertension in seven patients and imminent rupture or persistent pain in nine. Twenty chronic patients were operated due to dilatation (mean 6 cm). One patient died due to cardiac failure. One patient had a transient paraparesia and two had pulmonary embolism. No patient died in a follow up períod ranging from 2.5 to 74 months. Four patients required a new aortic endovascular procedure due to progressive dilatation or endoleak. Conclusión: Endovascular treatment of type B aortic dissection has good immediate andlong term results.

Interrupción de la vena cava inferior mediante filtros de inserción percutánea: Indicaciones y resultados en 287 pacientes / Percutaneous inferior vena cava filters: Indications and results in 287 patients

Background: Anticoagulation is the treatment of choice for deep vein thrombosis (DVT) and pulmonary embolism (PE). Occasionally this treatment is contraindicated or fails to prevent PE. In these patients, inferior vena caval (IVC) interruption is indicated and insertion of a filter is the most commonly performed procedure. Aim: To report the experience with IVC filters. Material and methods: Retrospective review of all medical records and operative protocols of patients subjected to IVC filter implantations. Follow up was performed by telephone contact with the patient, relatives or primary physicians, ambulatory consultation or by death certificates. Results: During the period 1993-2005 we implanted IVC filters on 287 patients, 55.4 percent male, average age: 62.1 yrs (17-99). Indications for the procedure were DVT or PE and contraindication of anticoagulation in 141 patients (49.1 percent), DVT or PE and complication of anticoagulation in 65 patients (22.6 percent), prophylaxis in 39 patients (13.6 percent), massive PE or poor respiratory function in 31 patients (10.8 percent), paradoxal emboli in 4 patients (1.4 percent) and other causes in seven patients. All percutaneous devices were successfully inserted. There was no morbidity or mortality related to the procedure. The most frequent access site was the internal jugular vein (66.6 percent). In 24 patients (8.4 percent) the filter was intentionally deployed above the renal veins. Six patients (2.1 percent) were lost to follow up after discharge. A mean follow up of 41.5 months was achieved. Ninety one patients died, with a 5 years survival of 64.7 percent. Symptomatic recurrent PE occurred in 6 patients (2.1 percent) and was the cause of death on 3 of them (1 percent), DVT has been detected in 22 patients (7.7 percent) during the follow up period. Conclusions: IVC filter implantation is a safe and effective short and long term measure to prevent PE and its consequences.

Abnormal development of the locomotor activity in yellow larvae of Drosophila: a cuticular defect?

The yellow (y) mutation of Drosophila melanogaster affects the development of behavior and morphology. We have analyzed some behavioral and morphological parameters during the development of y mutants. Wild-type third instar larvae move in straighter paths than larvae of the same age homozygous for the y mutation. At 96 h of age, the tracks of y larvae have 10 times as many loops as tracks of wild-type larvae, and at 120 h of age, y larvae show bending behavior about 2.5 times more frequently than do wild-type. Consequently, they do not disperse as much as wild-type larvae. Concomitant with the behavioral changes, the larvae present a defect in the morphology of large chaetae in the larval denticle belts, particularly of 2nd and 3rd instars, both with light and scanning electron microscopes. These results suggest that a cuticular defect is probably involved in the abnormal locomotor activity observed in y larvae of Drosophila melanogaster.

Blood markers in Alzheimer disease: subnormal acetylcholinesterase and butyrylcholinesterase in lymphocytes and erythrocytes.

In patients with the clinical diagnosis of Alzheimer disease (AD), we searched for systemic changes in components of the blood as a diagnostic tool. The acetylcholine-related enzymes acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE) were measured in plasma, erythrocytes, platelets and lymphocytes. Results did not show a general effect; notwithstanding, specific cell types presented alterations either in AChE or BuChE but not in both enzymatic activities. In AD patients, AChE of lymphocytes was reduced by 60% compared with the age-matched controls. However, when patients were divided, the sporadic but not the familial subgroup exhibited a significant reduction. In erythrocytes the BuChE activity was reduced by 45% in sporadic AD. The molecular forms of the lymphocyte AChE were characterized by velocity sedimentation. Both globular forms were subnormal, more so the tetrameric G4 AChE form than the G2 form.

Platelet of Alzheimer patients: increased counts and subnormal uptake and accumulation of [14C]5-hydroxytryptamine.

Platelets are the main source of 5-hydroxytryptamine (5-HT) and amyloid precursor protein (APP) found in plasma. We studied a possible correlation between platelet markers and the clinical diagnosis of Alzheimer disease (AD). Our results indicate that in AD patients: (a) platelets are elevated, (b) their ability to accumulate 5-HT decreases and, (c) the kinetic parameters of 5-HT uptake are altered (decreased Km and Vmax), compared to non-demented healthy individuals. An aged Down syndrome patient presents even more deviant alterations. Our findings supports the idea that platelets may provide a systemic marker of AD, and eventually be useful for the clinical diagnosis of the disease.

[Oral elimination of strobila segments of Taenia saginata]. / Eliminación oral de segmentos de estróbila de Taenia saginata.

Within a 14-24 hours lapse after gynecological operative surgery, a 27-year-old woman eliminated with vomit two large taperworm pieces, measuring 3 and 2 meters respectively. At the laboratory they were identified as Taenia saginata strobila with immature, mature and gravid proglottids. The patient informed that she liked to eat raw beef. Treatment consisted in a single dose of praziquantel: 15 mg/kg body weight. Parasitological controls (two series of three fecal samples each), performed three months later, resulted negative for Taenia eggs.

Corticosterone Reduces Synaptic Inhibition in Rat Hippocampal and Neocortical Neurons in vitro.

We examined the effect of corticosterone (10(-7) to 10(-5) M) on membrane properties and postsynaptic potentials, by means of intracellular recordings from neocortical and hippocampal CA1 pyramidal neurons of the intact adult rat in vitro. Corticosterone reduced both the early and the late components of the orthodromically-evoked inhibitory postsynaptic potential in both structures. The glucocorticoid receptor antagonist RU 38486 (10(-6) M) prevented this effect in the hippocampus. In hippocampal, but not in neocortical pyramidal neurons, corticosterone reduced a depolarizing membrane transient evoked by a depolarizing current step and increased the threshold for eliciting action potentials evoked by depolarizing current pulses. Corticosterone did not detectably alter the afterhyperpolarization following repetitive neuronal discharges evoked by current injection, in either the neocortex or in the hippocampus. Excitatory postsynaptic potentials, action potentials, membrane potential and membrane input resistance were also unchanged. The decrease in synaptic inhibition together with the reduction of electrical excitability in the hippocampus, would imply a modulation of response characteristics in pyramidal neurons such that repeated synaptic inputs become more efficient and low frequency input is blunted.

Interocular transfer of extinction of visual pattern discriminations in split-chiasm and split-brain cats.

The interocular transfer of the extinction of visual pattern discrimination was studied in cats with either section of optic chiasm (split-chiasm cats) or combined sections of chiasm and forebrain commissures (split-brain cats). Visual pattern discriminations were monocularly learned and their interocular transfer was assessed through the opposite eye. Then, learning was unilaterally extinguished and interocular transfer of extinction was tested on the other side. In split-chiasm cats, the total number of trials to extinction criterion (EC) was significantly lower with the second eye than with the first eye, indicating a successful interocular transfer. In split-brain cats, EC with the second eye was attained faster than with the first in some performances; it was similar with both eyes in other tasks, and with the second eye was higher than with the first in still other tasks. Statistical analysis applied to this group of split-brain cats pointed out that extinction performances with the two eyes were not significantly different. These findings suggest that interocular transfer of extinction was abolished in split-brain cats and that memory for extinction was unilaterally established in the absence of forebrain commissures.

The sensory projections of Drosophila mutants which show abnormal wing formation or flying behavior.

The central projection pattern of sensory neurones from the wing of Drosophila melanogaster arise from a small number of differentiated cell types which are localized in a precise and reproducible spatial pattern. We report here the distribution of the nerve pathways revealed by filling with peroxidase and the structure and number of the wing sensory receptors, in flies which have wings but which nevertheless are flightless, including one which presents abnormal wing formation. Our results indicate that in dumpy and taxi mutants, there are no detectable modifications in the neural projections or in the number and morphology of sensory receptors. Vestigial mutants however, present several alterations including the absence of the ovoid projection, a fact consistent with the existence of very few marginal bristles. The projection of the large companiform sensilla branch profusely along the ventromedial tract and more sensory fibers cross the midline in the mesothorax. Wings of vestigial mutants show a decrease in the number of large campaniform sensilla, and more importantly some receptors present abnormally oriented trichomes in the neighboring cells.

Enteroparasitosis en manipuladores de alimentos de la ciudad de Arica, I Región, Chile / Enteroparasitosis in food mamipulators of Arica City, I Region, Chile

Durante mayo a agosto de 1983 se estudiaron 180 manipuladores de alimentos de 52 establecimientos comerciales de la ciudad de Arica, realizando a cada uno de ellos, un examen coproparasitológico seriado. 108 (60%0 presentaron infección por parásitos o comensales intestinales. La especie de mayor prevalencia fue ENDOLIMAX NANA (42,2%). Entre los patógenos se encontró GIARDIA LAMBLIA (9,4%), ENTAMOEBA HISTOLYTICA (5%) y los helmintos HYMENOLEPIS NANA (1,1%) y TRICHURIS TRICHIURA (0,6%). Con respecto al tipo de establecimientos, la mayor tasa de infección fue encontrada en los individuos provenientes de panaderías (77,8%) y fuentes de soda (63%)

[Ovarian pregnancy in a user of the lippes loop (clinical case)]. / Embarazo ovárico en esuaria de asa de Lippes (caso clínico).

PIP: Ovarian pregnancy is the rarest of all ectopic pregnancy, occurring in about 0.5% of all cases. This article describes 1 such case, in a 24 year old healthy, multiparous woman. The woman, wearer of a Lippes Loop, was hospitalized for pregnancy with IUD in situ. Diagnosis was done through echography, which clearly showed the IUD, laparoscopy and finally laparotomy, which showed a very much enlarged right ovary. Right oophorectomy was performed and the patient recovered promptly. Histological examination of the resected ovary confirmed the presence of an ovarian pregnancy. The article stresses the importance of correct diagnosis in all cases of ectopic pregnancy.^ieng